OpenUCT :: Browsing by Subject "Uganda"

Browsing by Subject "Uganda"

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Open Access
A comparison of the conditional inference survival forest model to random survival forests based on a simulation study as well as on two applications with time-to-event data
(2017) Nasejje, Justine B; Mwambi, Henry; Sabur, Natasha F; Lesosky, Maia
Abstract Background Random survival forest (RSF) models have been identified as alternative methods to the Cox proportional hazards model in analysing time-to-event data. These methods, however, have been criticised for the bias that results from favouring covariates with many split-points and hence conditional inference forests for time-to-event data have been suggested. Conditional inference forests (CIF) are known to correct the bias in RSF models by separating the procedure for the best covariate to split on from that of the best split point search for the selected covariate. Methods In this study, we compare the random survival forest model to the conditional inference model (CIF) using twenty-two simulated time-to-event datasets. We also analysed two real time-to-event datasets. The first dataset is based on the survival of children under-five years of age in Uganda and it consists of categorical covariates with most of them having more than two levels (many split-points). The second dataset is based on the survival of patients with extremely drug resistant tuberculosis (XDR TB) which consists of mainly categorical covariates with two levels (few split-points). Results The study findings indicate that the conditional inference forest model is superior to random survival forest models in analysing time-to-event data that consists of covariates with many split-points based on the values of the bootstrap cross-validated estimates for integrated Brier scores. However, conditional inference forests perform comparably similar to random survival forests models in analysing time-to-event data consisting of covariates with fewer split-points. Conclusion Although survival forests are promising methods in analysing time-to-event data, it is important to identify the best forest model for analysis based on the nature of covariates of the dataset in question.
Open Access
A critical analysis of the Ugandan Companies Act, 2012, in the search for an appropriate legal framework for small and closely-held companies in the light of the experiences of South Africa and the United Kingdom
(2024) Engoru, Ivan; Idensohn, Kathleen; Yeats, Jacqueline
This study set out to determine whether the Ugandan Companies Act, 2012 (‘CA 2012') provides an appropriate and effective legal framework for small and closely-held companies (‘SCHCs'). In this study, SCHCs are small owner-managed companies with one or a few members with close relations who are usually natural persons. The study focus follows from a recognition that companies' legislation in Uganda is complex and makes little attempt to provide simple, flexible and accessible law for the operations of SCHCs. Although this gap was highlighted during the enactment of CA 2012, it had also characterised previous companies' legislation in Uganda. The expectation was that CA 2012 would address this gap. However, there is doubt if this has been achieved. To be sure, what amounts to simple, flexible and accessible legislation for SCHCs is not obvious. However, a look at the relevant legislation in the comparable jurisdictions of South Africa and the United Kingdom suggests that SCHCs require special recognition and treatment in legislation in the areas of audits; financial reporting; limitation of membership; restriction of members to natural persons; and clear optional provisions. This can be achieved through a distinct corporate form in terms of a separate and distinct legislation for SCHCs or by treating SCHCs as private companies under a single company law statute, but with flexible provisions. In discharging this task, the study examines the various business forms under CA 2012 (ss 2, 4 and 5), and the corporate governance framework (ss 14, 138, 154, and 167). Through doctrinal analysis, it employs the evaluative framework of fewer reporting obligations; limiting membership in SCHCs to natural persons; limiting members who are also usually in management; and clear elective or optional provisions for SCHCs in areas such as company meetings and audits, as best practice on the regulation of SCHCs. The study draws on the experiences of South Africa under the Close Corporations Act 69 of 1984 (‘CCA 84') and South African Companies Act, 71 of 2008 (‘CA 2008'); and the UK's Companies Act, No. 46 of 2006 (‘CA 2006') as comparable jurisdictions; and the application of common law in companies' legislation. In the latter, I examine specifically the common law concept of quasi-partnership companies, and its' utility in the SCHCs category, and codification of common law in companies' legislation, as a growing drafting style. I draw some lessons from the UK and South Africa. The key arguments in this study are that first, the business forms and legal categories under CA 2012 do not align with the known legal definition or 2 characterisation of SCHCs. They are classified along the traditional lines of private versus public or unregistered versus registered companies. The single member company (‘SMC') is a new concept in Uganda's company law and is exclusive to single members. This does not cater for SCHCs. Second, the Code of Corporate Governance (‘CoCG') (s 14), although optional for private companies, contains complex concepts which are inapplicable to SCHCs. Thus, CoCG's significance to SCHCs' corporate governance needs is doubtful. Thirdly, the requirements for accounts reporting (s 154) and audit (s 167) are mandatory for all companies irrespective of their size or type. These provisions are elaborate with prescribed formats. Subjecting SCHCs to the same regulatory requirements as the other companies is burdensome and contrary to best practice. Finally, the comparable jurisdictions of the UK and South Africa have codified aspects of common law by way of a restatement of the law in their respective companies' legislation. A restatement serves two purposes. First, it directly integrates common law into statute; and second, affords the courts the flexibility to fill gaps that may exist in statute. This study contends that this tool (also loosely referred to as ‘codification') has not been well utilised in CA 2012 with respect to SCHCs. The study concludes that CA 2012 does not provide an appropriate and effective legal framework for SCHCs. Consequently, in keeping with best practice on the regulation of SCHCs as can be seen in comparable jurisdictions of South Africa and the UK, the study proposes amendments to ss 2, 4, 5, 138, 154, and 167 of CA 2012 to provide for the special regulation of SCHCs either (a) by creating a new type of company and rendering it subject to separate regulatory provisions or (b) to a ‘reduced' version of the regulatory provisions applicable to other companies; or by continuing to treat SCHCs as private companies and rendering them subject to a ‘reduced' version of the regulatory provisions applicable to other companies. To give effect to these proposals will require: (1) merging SMC with other smaller companies whose members do not exceed ten to create SCHCs founded on partnership principles; (2) inserting a chapter in CA 2012 with clear provisions which apply to SCHCs; (3) restricting membership of SCHCs to natural persons; and (4) inserting a general statement of purpose by way of a substantive provision in CA 2012 to the effect that in its interpretation the common law shall apply as a direct way of integrating the common law in CA 2012, as other jurisdictions have done. The study provides in Appendix B a Schedule of the proposed amendments and their justification to aid policy reforms and the review of CA 2012 with respect to SCHCs in Uganda.
Open Access
Alcohol use in a rural district in Uganda: findings from community-based and facility-based cross-sectional studies
(BioMed Central, 2018-04-03) Nalwadda, Oliva; Rathod, Sujit D; Nakku, Juliet; Lund, Crick; Prince, Martin; Kigozi, Fred
Background Uganda has one of the highest per capita alcohol consumption rates in sub-Saharan Africa. However, the prevalence of alcohol use disorders (AUD) remains unknown in many areas, especially in rural districts. This study aimed to estimate the prevalence of alcohol consumption and of alcohol use disorder among men, and to describe the distribution of drinking intensity, among men in in Kamuli District, Uganda. Methods Men attending primary care clinics in Kamuli District were consecutively interviewed in a facility-based cross-sectional study, and a separate group of men were interviewed in a population-based cross-sectional study. In both studies the men were administered a structured questionnaire, which included the alcohol use disorder identification test (AUDIT) to screen for AUD, as well as sections about demographic characteristics, depression screening, internalized stigma for alcohol problems and treatment-seeking. Results Among the 351 men enrolled in the Community study, 21.8% consumed alcohol in the past 12 months, compared to 39.6% of 778 men in the Facility Survey. The proportion of men who screened positive for AUD was 4.1% in the community study and 5.8% in the facility study. AUDIT scores were higher among older men, men with paid/self-employment status and higher PHQ-9 score (P < 0.05). Nearly half (47.5%) of the men with AUDIT-positive scores reported that alcohol use problems had ruined their lives. A majority (55.0%) of men with AUDIT-positive scores did not seek treatment because they did not think AUD was a problem that could be treated. Conclusions Internalized stigma beliefs among AUDIT-positive men impede treatment-seeking. As part of any efforts to increase detection and treatment services for alcohol use problems, routine screening and brief interventions for internalized stigma must be incorporated within the normal clinical routine of primary health care.
Open Access
An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia
(BioMed Central Ltd, 2011) Faydi, Edwige; Funk, Michelle; Kleintjes, Sharon; Ofori-Atta, Angela; Ssbunnya, Joshua; Mwanza, Jason; Kim, Caroline; Flisher, Alan
BACKGROUND: Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. METHODS: The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached. RESULTS: All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities. CONCLUSIONS: Six gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.
Open Access
Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countries
(Public Library of Science, 2014) Hanlon, Charlotte; Luitel, Nagendra P; Kathree, Tasneem; Murhar, Vaibhav; Shrivasta, Sanjay; Medhin, Girmay; Ssebunnya, Joshua; Fekadu, Abebaw; Shidhaye, Rahul; Petersen, Inge
BACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.
Open Access
Co-creating a culturally relevant programme for enabling participation of children with brain injury in Uganda (CEBU)
(2025) Ekwan, Francis Uzu; Sonday, Amshuda; Gretschel, Pamela Joy; Pamela Joy
Background: The Culturally Relevant Programme Enabling Participation of Children with Brain Injury in Uganda was co-created to address the occupational needs of children with brain injury aged four months to 17 years, as well as the well-being of their caregivers. Aim and Purpose: The aim of this thesis was to co-create a culturally relevant programme for enabling participation of children with brain injury in Uganda and describe its co-creation process. The purpose was to improve children's activity functioning and survival following brain injury, and impact on caregivers' health. Methods: Three studies were implemented in two phases following participatory action research design. Phase one explored the participants' thoughts, feelings, and perceptions of the usual intervention in Kampala-Wakiso Brain Injury Home: Therapy Centre (KWB-HTC) Uganda. In phase two, a culturally relevant programme enabling participation of children with brain injury was co-created; its consequences and limitations described. Purposive selection of primary participants (eight brain injured children) and general participants (eleven health professionals and three caregivers) took place. Video data were collected from each primary participant in the usual intervention, action changes. Interview data were collected from general participants in group reflection and individual interview. Thematic analysis was used to analyse data collected. Findings: Thematic analysis of data collected identified three main themes: The first theme, “an intervention that does not satisfy basic needs,” linked to three sub-themes: “ignorance of child's condition,” “assessment that does not focus on functional issues,” and “unwitting goals.” The second theme, “bridging basic needs and enablement,” linked to three sub-themes: “assessing child enablement contexts,” “supporting caregivers to attain psychological health,” and “involving the child in daily life activities.” The third theme, “diversifying daily life participation,” linked to two sub-themes: “forming community connectedness,” and “moderating caregiver constraints.” Conclusion: In conclusion, every child with brain injury in Uganda deserves an intervention that satisfies basic needs, co-created as the Four-star Model for Enablement and Participation. To implement the Four-star Model, this thesis proposed Occupation Actualization (OA) philosophy which requires children with brain injury to be involved in daily life activities formed by occupation scale and occupation score. The Occupation Actualization philosophy assumes that there is a positive relationship between occupation scale, occupation score, and enablement within the guiding principles of the Four-star Model delivered through community connectedness at the African One Hospital. Further research is recommended to implement and evaluate the effectiveness of the Four-star Model in Uganda, and test the validity of the OA philosophy.
Open Access
Combined HIV Adolescent Prevention Study (CHAPS): comparison of HIV pre-exposure prophylaxis regimens for adolescents in sub-Saharan Africa—study protocol for a mixed-methods study including a randomised controlled trial
(2020-10-30) Nash, S; Dietrich, J; Ssemata, A S; Herrera, C; O’Hagan, K; Else, L; Chiodi, F; Kelly, C; Shattock, R; Chirenje, M; Lebina, L; Khoo, S; Bekker, L-G; Weiss, H A; Gray, C; Stranix-Chibanda, L.; Kaleebu, P; Seeley, J; Martinson, N; Fox, J
Background HIV remains a major public health issue, especially in Eastern and Southern Africa. Pre-exposure prophylaxis is highly effective when adhered to, but its effectiveness is limited by cost, user acceptability and uptake. The cost of a non-inferiority phase III trial is likely to be prohibitive, and thus, it is essential to select the best possible drug, dose and schedule in advance. The aim of this study, the Combined HIV Adolescent PrEP and Prevention Study (CHAPS), is to investigate the drug, dose and schedule of pre-exposure prophylaxis (PrEP) required for the protection against HIV and the acceptability of PrEP amongst young people in sub-Saharan Africa, and hence to inform the choice of intervention for future phase III PrEP studies and to improve strategies for PrEP implementation. Methods We propose a mixed-methods study amongst young people aged 13–24 years. The first component consists of qualitative research to identify the barriers and motivators towards the uptake of PrEP amongst young people in South Africa, Uganda and Zimbabwe. The second component is a randomised clinical trial (ClinicalTrials.gov NCT03986970, June 2019) using a novel ex vivo HIV challenge method to investigate the optimal PrEP treatment (FTC-TDF vs FTC-TAF), dose and schedule. We will recruit 144 amongst HIV-negative uncircumcised men aged 13–24 years from voluntary male medical circumcision clinics in two sites (South Africa and Uganda) and randomise them into one of nine arms. One group will receive no PrEP prior to surgery; the other arms will receive either FTC-TDF or FTC-TAF, over 1 or 2 days, and with the final dose given either 6 or 20 h prior to surgery. We will conduct an ex vivo HIV challenge on their resected foreskin tissue. Discussion This study will provide both qualitative and quantitative results to help decide the optimum drug, dose and schedule for a future phase III trial of PrEP. The study will also provide crucial information on successful strategies for providing PrEP to young people in sub-Saharan Africa. Trial registration ClinicalTrials.gov NCT03986970 . Registered on 14 June 2019
Open Access
Creating an African HIV clinical research and prevention trials network: HIV prevalence, incidence and transmission
(Public Library of Science, 2015) Kamali, Anatoli; Price, Matt A; Lakhi, Shabir; Karita, Etienne; Inambao, Mubiana; Sanders, Eduard J; Anzala, Omu; Latka, Mary H; Bekker, Linda-Gail; Kaleebu, Pontiano
HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner.
Open Access
Density of healthcare providers and patient outcomes: evidence from a nationally representative multi-site HIV treatment program in Uganda
(Public Library of Science, 2011) Bakanda, Celestin; Birungi, Josephine; Mwesigwa, Robert; Zhang, Wendy; Hagopian, Amy; Ford, Nathan; Mills, Edward J
Objective We examined the association between density of healthcare providers and patient outcomes using a large nationally representative cohort of patients receiving combination antiretroviral therapy (cART) in Uganda. Design We obtained data from The AIDS Support Organization (TASO) in Uganda. Patients 18 years of age and older who initiated cART at TASO between 2004 and 2008 contributed to this analysis. The number of healthcare providers per 100 patients, the number of patients lost to follow-up per 100 person years and number of deaths per 100 person years were calculated. Spearman correlation was used to identify associations between patient loss to follow-up and mortality with the healthcare provider-patient ratios. RESULTS: We found no significant associations between the number of patients lost to follow-up and physicians ( p = 0.45), nurses ( p = 0.93), clinical officers ( p = 0.80), field officers ( p = 0.56), and healthcare providers overall ( p = 0.83). Similarly, no significant associations were observed between mortality and physicians ( p = 0.65), nurses ( p = 0.49), clinical officers ( p = 0.73), field officers ( p = 0.78), and healthcare providers overall ( p = 0.73). CONCLUSIONS: Patient outcomes, as measured by loss to follow-up and mortality, were not significantly associated with the number of doctors, nurses, clinical officers, field officers, or healthcare providers overall. This may suggest that that other factors, such as the presence of volunteer patient supporters or broader political or socioeconomic influences, may be more closely associated with outcomes of care among patients on cART in Uganda.
Open Access
Developing, implementing, and monitoring tailored strategies for integrated knowledge translation in five sub-Saharan African countries
(BioMed Central, 2023-09-04) Sell, Kerstin; Jessani, Nasreen S.; Mesfin, Firaol; Rehfuess, Eva A.; Rohwer, Anke; Delobelle, Peter; Balugaba, Bonny E.; Schmidt, Bey-Marrié; Kedir, Kiya; Mpando, Talitha; Niyibizi, Jean B.; Osuret, Jimmy; Bayiga-Zziwa, Esther; Kredo, Tamara; Mbeye, Nyanyiwe M.; Pfadenhauer, Lisa M.
Background Integrated knowledge translation (IKT) through strategic, continuous engagement with decision-makers represents an approach to bridge research, policy and practice. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA +), comprising research institutions in Ethiopia, Malawi, Rwanda, South Africa, Uganda and Germany, developed and implemented tailored IKT strategies as part of its multifaceted research on prevention and care of non-communicable diseases and road traffic injuries. The objective of this article is to describe the CEBHA + IKT approach and report on the development, implementation and monitoring of site-specific IKT strategies. Methods We draw on findings derived from the mixed method IKT evaluation (conducted in 2020–2021), and undertook document analyses and a reflective survey among IKT implementers. Quantitative data were analysed descriptively and qualitative data were analysed using content analysis. The authors used the TIDieR checklist to report results in a structured manner. Results Preliminary IKT evaluation data (33 interviews with researchers and stakeholders from policy and practice, and 31 survey responses), 49 documents, and eight responses to the reflective survey informed this article. In each of the five African CEBHA + countries, a site-specific IKT strategy guided IKT implementation, tailored to the respective national context, engagement aims, research tasks, and individuals involved. IKT implementers undertook a variety of IKT activities at varying levels of engagement that targeted a broad range of decision-makers and other stakeholders, particularly during project planning, data interpretation, and output dissemination. Throughout the project, the IKT teams continued to tailor IKT strategies informally and modified the IKT approach by responding to ad hoc engagements and involving non-governmental organisations, universities, and communities. Challenges to using systematic, formalised IKT strategies arose in particular with respect to the demand on time and resources, leading to the modification of monitoring processes. Conclusion Tailoring of the CEBHA + IKT approach led to the inclusion of some atypical IKT partners and to greater responsiveness to unexpected opportunities for decision-maker engagement. Benefits of using systematic IKT strategies included clarity on engagement aims, balancing of existing and new strategic partnerships, and an enhanced understanding of research context, including site-specific structures for evidence-informed decision-making.
Restricted
Genetic analysis of maize streak virus isolates from Uganda reveals widespread distribution of a recombinant variant.
(Microbiology Society, 2007) Owor, Betty E; Martin, Darren P; Shepherd, Dionne N; Edema, Richard; Monjane, Ade´rito L; Rybicki, Edward P; Thomson, Jennifer A; Vasani, Arvind
Maize streak virus (MSV) contributes significantly to the problem of extremely low African maize yields. Whilst a diverse range of MSV and MSV-like viruses are endemic in sub-Saharan Africa and neighbouring islands, only a single group of maize-adapted variants – MSV subtypes A1–A6 – causes severe enough disease in maize to influence yields substantially. In order to assist in designing effective strategies to control MSV in maize, a large survey covering 155 locations was conducted to assess the diversity, distribution and genetic characteristics of the Ugandan MSV-A population. PCR–restriction fragment-length polymorphism analyses of 391 virus isolates identified 49 genetic variants. Sixty-two full-genome sequences were determined, 52 of which were detectably recombinant. All but two recombinants contained predominantly MSV-A1-like sequences. Of the ten distinct recombination events observed, seven involved inter-MSV-A subtype recombination and three involved intra-MSV-A1 recombination. One of the intra-MSV-A1 recombinants, designated MSV-A1UgIII, accounted for .60 % of all MSV infections sampled throughout Uganda. Although recombination may be an important factor in the emergence of novel geminivirus variants, it is demonstrated that its characteristics in MSV are quite different from those observed in related African cassava-infecting geminivirus species.
Open Access
Hybrid organisations in global value chains: insights from Uganda's coffee sector
(2025) Mukanza, Patrick; Surmeier, Annika
Global value chains (GVCs) represent a core paradox of modern capitalism. While they generate employment opportunities in emerging economies, they also contribute to systemic inequalities, precarious labour, and environmental degradation. In response, upgrading has been proposed as a strategy for organisations to improve their position, capture value, and address social or environmental concerns. Hybrid organisations, those blending commercial and social goals, are increasingly recognised as important actors capable of challenging dominant GVC dynamics by promoting inclusive and sustainable upgrading. However, their role in African contexts remains under-researched. This study addresses this gap by investigating how hybrid organisations in Uganda's coffee sector contribute to GVC upgrading processes, by focusing on the challenges and opportunities they encounter. Uganda's coffee sector, which supports 1.8 million smallholder households and accounts for 22% of the country's export earnings, faces challenges such as price volatility, unequal power relations between local and international actors, weak infrastructure, and climate threats. These difficulties are indicative of broader global inequalities, in which, smallholder farmers in the global South commonly create value that is largely captured in the global North. Drawing on 49 interviews conducted across Uganda, the United Kingdom, and the United States, with stakeholders including farmers, hybrid organisation managers, industry experts, state actors, and international traders, the study applies a value chain analysis and examines 13 hybrid organisations using a comparative case study approach. Empirically, the findings show that hybrid organisations, positioned between smallholder farmers and international traders, contribute to economic upgrading by engaging in functional upgrading strategies such as domestic roasting, direct trade to consumer markets, and moving processing stages closer to origin. They also seek to enhance value capture at the local level by strengthening farmers' capabilities in quality control and post-harvest handling, which contributes to both product and process upgrading. In terms of social and economic upgrading, hybrids support more stable and inclusive farmer participation in the value chain by extending microloans, offering pre-financing to support farm-level investments, and providing agronomic training that strengthens farmers' agency and market positioning. Environmental upgrading is also promoted by hybrids through the adoption of climate- resilient practices, including agroforestry, composting, and soil management, which help farmers adapt to climate threats while improving long-term productivity. Yet these efforts face constraints. These include limited access to affordable finance, especially among locally embedded hybrids, and policy directions that are not well aligned with the quality-focused, socially embedded strategies many hybrids pursue. Conceptually, the study shows that hybrid organisations do not simply operate in weak institutional environments, they emerge in response to them. In areas where public or market-based support structures fall short, hybrids have emerged and filled such gaps. Their ability to combine commercial and social goals, and to work collaboratively across sectors and actors, positions them as relevant partners in efforts to promote more inclusive and sustainable upgrading in coffee value chains.
Open Access
‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda
(2022-07-15) Alhassan, Yussif; Twimukye, Adelline; Malaba, Thokozile; Myer, Landon; Waitt, Catriona; Lamorde, Mohammed; Colbers, Angela; Reynolds, Helen; Khoo, Saye; Taegtmeyer, Miriam
Background Many women in sub-Saharan Africa initiate antenatal care (ANC) late in pregnancy, undermining optimal prevention of mother-to-child-transmission (PMTCT) of HIV. Questions remain about whether and how late initiation of ANC in pregnancy is related to adherence to antiretroviral therapy (ART) in the era of national dolutegravir roll-out. Methods This study employed a qualitative design involving individual interviews and focus group discussions conducted between August 2018 and March 2019. We interviewed 37 pregnant and lactating women living with HIV selected purposively for early or late presentation to ANC from poor urban communities in South Africa and Uganda. Additionally, we carried out seven focused group discussions involving 67 participants in both countries. Data were analysed thematically in NVivo12. Results Women described common underlying factors influencing both late ANC initiation and poor ART adherence in South Africa and Uganda. These included poverty and time constraints; inadequate health knowledge; perceived low health risk; stigma of HIV in pregnancy; lack of disclosure; and negative provider attitudes. Most late ANC presenters reported relationship problems, lack of autonomy and the limited ability to dialogue with their partners to influence household decisions on health and resource allocation. Perception of poor privacy and confidentiality in maternity clinics was rife among women in both study settings and compounded risks associated with early disclosure of pregnancy and HIV. Women who initiated ANC late and were then diagnosed with HIV appeared to be more susceptible to poor ART adherence. They were often reprimanded by health workers for presenting late which hampered their participation in treatment counselling and festered provider mistrust and subsequent disengagement in care. Positive HIV diagnosis in late pregnancy complicated women’s ability to disclose their status to significant others which deprived them of essential social support for treatment adherence. Further, it appeared to adversely affect women’s mental health and treatment knowledge and self-efficacy. Conclusions We found clear links between late initiation of ANC and the potential for poor adherence to ART based on common structural barriers shaping both health seeking behaviours, and the adverse impact of late HIV diagnosis on women’s mental health and treatment knowledge and efficacy. Women who present late are a potential target group for better access to antiretrovirals that are easy to take and decrease viral load rapidly, and counselling support with adherence and partner disclosure. A combination of strengthened health literacy, economic empowerment, improved privacy and patient-provider relationships as well as community interventions that tackle inimical cultural practices on pregnancy and unfair gender norms may be required.
Open Access
“It’s only fatness, it doesn’t kill”: a qualitative study on perceptions of weight gain from use of dolutegravir-based regimens in women living with HIV in Uganda
(2022-06-21) Alhassan, Yussif; Twimukye, Adelline; Malaba, Thokozile; Myer, Landon; Waitt, Catriona; Lamorde, Mohammed; Colbers, Angela; Reynolds, Helen; Khoo, Saye; Taegtmeyer, Miriam
Background Dolutegravir (DTG)-based regimens have been recommended by the WHO as the preferred first-line and second-line HIV treatment in all populations. Evidence suggests an association with weight gain, particularly among black women. Our study investigated perceptions of weight gain from DTG-based regimen use on body image and adherence of antiretroviral therapy in women living with HIV (WLHIV) in Uganda. Methods Between April and June 2021, we conducted semi-structured interviews involving 25 WLHIV (adolescents, women of reproductive potential and post-menopausal women) and 19 healthcare professionals (clinicians, nurses, ART managers and counsellors) purposively selected from HIV clinics in Kampala. The interviews explored perceptions of body weight and image; experiences and management of weight related side effects associated with DTG; and knowledge and communication of DTG-related risks. Data was analysed thematically in NVivo 12 software. Results Our findings indicate WLHIV in Uganda commonly disliked thin body size and aspired to gain moderate to high level body weight to improve their body image, social standing and hide their sero-positive status. Both WLHIV and healthcare professionals widely associated weight gain with DTG use, although it was rarely perceived as an adverse event and was unlikely to be reported or to alter medication adherence. Clinical management and pharmacovigilance of DTG-related weight gain were hampered by the limited knowledge of WLHIV of the health risks of being over-weight and obesity; lack of diagnostic equipment and resources; and limited clinical guidance for managing weight gain and associated cardiovascular and metabolic comorbidities. Conclusions The study highlights the significance of large body-size in promoting psychosocial wellbeing in WLHIV in Uganda. Although weight gain is recognized as a side effect of DTG, it may be welcomed by some WLHIV. Healthcare professionals should actively talk about and monitor for weight gain and occurrence of associated comorbidities to facilitate timely interventions. Improved supply of diagnostic equipment and support with sufficient guidance for managing weight gain for healthcare professionals in Uganda are recommended.
Open Access
Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda
(BioMed Central Ltd, 2011) Mills, Edward; Bakanda, Celestin; Birungi, Josephine; Chan, Keith; Hogg, Robert; Ford, Nathan; Nachega, Jean; Cooper, Curtis
BACKGROUND:Because men in Africa are less likely to access HIV/AIDS care than women, we aimed to determine if men have differing outcomes from women across a nationally representative sample of adult patients receiving combination antiretroviral therapy in Uganda. METHODS: We estimated survival distributions for adult male and female patients using Kaplan-Meier, and constructed multivariable regressions to model associations of baseline variables with mortality. We assessed person-years of life lost up to age 55 by sex. To minimize the impact of patient attrition, we assumed a weighted 30% mortality rate among those lost to follow up. RESULTS: We included data from 22,315 adults receiving antiretroviral therapy. At baseline, men tended to be older, had lower CD4 baseline values, more advanced disease, had pulmonary tuberculosis and had received less treatment follow up (all at p < 0.001). Loss to follow up differed between men and women (7.5 versus 5.9%, p < 0.001). Over the period of study, men had a significantly increased risk of death compared with female patients (adjusted hazard ratio 1.43, 95% CI 1.31-1.57, p < 0.001). The crude mortality rate for males differed importantly from females (43.9, 95% CI 40.7-47.0/1000 person-years versus 26.9, 95% CI 25.4-28.5/1000 person years, p < 0.001). The probability of survival was 91.2% among males and 94.1% among females at 12 months. Person-years of life lost was lower for females than males (689.7 versus 995.9 per 1000 person-years, respectively). CONCLUSIONS: In order to maximize the benefits of antiretroviral therapy, treatment programmes need to be gender sensitive to the specific needs of both women and men. Particular efforts are needed to enroll men earlier into care.
Open Access
Mediated mimbar: muslim media and identity in Uganda
(2025) Nsobya, Abdulhakim; Brigaglia, Andrea; Tayob, Abdulkader
Motivated by the scarcity of literature on the relationship between Muslims and media in East Africa, and Uganda in particular, this thesis examines the transformative role of new media in shaping the Islamic identity in Uganda. Since the liberalization of media in 1992, Ugandan Muslims have increasingly adopted new media, integrating it into their daily lives and religious practices. The study argues that new media has become a crucial platform for negotiating Islamic identity, serving as space where power, representation, and religious expression are contested and redefined. Drawing on interviews with media practitioners, scholars, and media consumers, the study has explored the motivations, strategies, and attitudes, that guide Muslims in their engaged with new media. Historically, Ugandan Muslims relied on the mosque Minbar and religious festivals as primary avenues for communication, particularly to express social and economic grievances. With limited access to the national broadcaster, these traditional platforms were essential for intra-faith debate and theological discourse. However, the advent of new media has significantly altered this landscape. New media now functions as a powerful tool for addressing issues of misrepresentation and marginalisation, providing a discursive space for diverse and often conflicting views within the Muslim community. The study highlights the rise of Salafism as a dominant voice in Ugandan media, using new theology to promote its theological perspective while rejecting opposing views. Additionally, radical groups like Allied Democratic Forces (ADF) have leveraged social media to reach a broader audience, bypassing traditional media gate keepers. This thesis contributes to the academic study of religion and media by offering an in-depth analysis of how new media facilitate the articulation of Islamic identity in Uganda. It underscores the importance of new media as a site of power struggles among reformists, traditionalist, modernists, and radical factions within Islam, each striving to shape the narrative and influence the future of the faith in Uganda.
Open Access
Motivational determinants of physical activity in disadvantaged populations with (pre)diabetes: a cross-cultural comparison
(BioMed Central, 2022-01-24) De Man, Jeroen; Kasujja, Francis X; Delobelle, Peter; Annerstedt, Kristi S; Alvesson, Helle M; Absetz, Pilvikki; Wouters, Edwin; Daivadanam, Meena; Guwatudde, David; Puoane, Thandi; Remmen, Roy; Tabana, Hanani; Van Olmen, Josefien
Background Understanding motivational determinants of physical activity (PA) is essential to guide the implementation of PA at individual and population level. Knowledge about the cross-cultural generalizability of these determinants is lacking and they have mostly been studied as separate factors. This study compares a motivational process model across samples from diverse populations with, or at risk of diabetes. Methods Measurement invariance of barrier identified regulation, barrier self-efficacy and social support was assessed in a rural Ugandan sample (n = 712) and disadvantaged samples with high proportions of immigrants in urban South Africa (n = 566) and Sweden (n = 147). These motivational determinants were then compared through multigroup structural equation modeling. Results The studied motivational constructs showed scalar invariance. Latent mean levels of perceived social support and barrier self-efficacy were lower in South Africa and Sweden. Structural models (for different PA outcomes) were not consistent across settings except for the association between perceived social support and identified regulation. Identified regulation was only associated with vigorous PA in Uganda and with moderate PA in South Africa. The association between social support and PA outcomes ranged from weak to not significant and the association between self-efficacy and PA was not significant. Self-reported PA was highest in Uganda and lowest in Sweden. Self-reported vigorous PA was significantly related to lower hemoglobin A1c levels, while moderate PA was not. Conclusions Findings suggest that: 1) it is feasible to compare a motivational process model across diverse settings; 2) there is lower perceived social support and self-efficacy in the urban, migrant samples; 3) identified regulation is a more promising determinant of PA than self-efficacy or social support in these populations; 4) associations between motivational determinants and PA depend on the perceived type and/or intensity of PA; 5) perceived relatedness functions as a basic psychological need across diverse settings; and 6) people’s perception of the PA they perform depends on their perceived level of intensity of PA which would have major implications for health promotion.
Open Access
An overview of Uganda's mental health care system: results from an assessment using the world health organization's assessment instrument for mental health systems (WHO-AIMS)
(BioMed Central Ltd, 2010) Kigozi, Fred; Ssebunnya, Joshua; Kizza, Dorothy; Cooper, Sara; Ndyanabangi, Sheila; Mental Health and Poverty Project
BACKGROUND: The Ugandan government recognizes mental health as a serious public health and development concern, and has of recent implemented a number of reforms aimed at strengthening the country's mental health system. The aim of this study was to provide a profile of the current mental health policy, legislation and services in Uganda. METHODS: A survey was conducted of public sector mental health policy and legislation, and service resources and utilisation in Uganda, in the year 2005, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2. RESULTS: Uganda's draft mental health policy encompasses many positive reforms, including decentralization and integration of mental health services into Primary Health Care (PHC). The mental health legislation is however outdated and offensive. Services are still significantly underfunded (with only 1% of the health expenditure going to mental health), and skewed towards urban areas. Per 100,000 population, there were 1.83 beds in mental hospitals, 1.4 beds in community based psychiatric inpatient units, and 0.42 beds in forensic facilities. The total personnel working in mental health facilities were 310 (1.13 per 100,000 population). Only 0.8% of the medical doctors and 4% of the nurses had specialized in psychiatry. CONCLUSION: Although there have been important developments in Uganda's mental health policy and services, there remains a number of shortcomings, especially in terms of resources and service delivery. There is an urgent need for more research on the current burden of mental disorders and the functioning of mental health programs and services in Uganda.
Open Access
Patent protection and foreign direct investment in Uganda's mining sector: a legal analysis of intellectual property as an investment incentive
(2025) Ntambi, Blair; Tong, Lee-Ann
A conducive legal environment is a major attraction of foreign investment into a country. When potential investors are making investment decisions, they meticulously examine the laws and policies tailored by the host country to protect and manage their business assets, among other things. Examples of such laws include intellectual property laws that are categorised based on the specific intellectual rights associated with the technological innovations that the investor intends to employ in the host state. This thesis delves into Uganda's patent law ecosystem, specifically exploring how it can be strategically leveraged, by way of packaging it as an investment incentive, to attract greater foreign direct investment (FDI) in the country's mining sector. The country's mining sector is characterised by its intensive requirement for both capital and technological expertise. In so doing, the thesis makes the case that whereas tax incentives are often welcomed by foreign investors, those in technology-intensive sectors, such as mining, seek more comprehensive legal safeguards. Robust legal regimes, particularly patent regimes, are highly attractive as they shield investors' technological assets from misappropriation and infringement.
Open Access
Potential strategies for sustainably financing mental health care in Uganda
(BioMed Central, 2018-12-05) Ssebunnya, J.; Kangere, S.; Mugisha, J.; Docrat, S.; Chisholm, D.; Lund, C.; Kigozi, F.
Abstract Background In spite of the pronounced adverse economic consequences of mental, neurological, and substance use disorders on households in most low- and middle-income countries, service coverage and financial protection for these families is very limited. The aim of this study was to generate potential strategies for sustainably financing mental health care in Uganda in an effort to move towards increased financial protection and service coverage for these families. Methods The process of identifying potential strategies for sustainably financing mental health care in Uganda was guided by an analytical framework developed by the Emerging Mental health systems in low and middle income countries (EMERALD project). Data were collected through a situational analysis (public health burden assessment, health system assessment, macro fiscal assessment) and eight key informant interviews with selected stakeholders from sectors including health, finance and civil society. The situational analysis provided contextualization for the strategies, and was complimented by views from key informant interviews. Results Findings indicate that the following strategies have the greatest potential for moving towards more equitable and sustainable mental health financing in the Uganda context: implementing National Health Insurance Scheme; shifting to Results Based Financing; decentralizing mental health services that can be provided at community level; and continued advocacy with decision makers with evidence through research. Conclusion Although several options were identified for sustainably financing mental health care in Uganda, the National Health Insurance Scheme seemed the most viable option. However, for the scheme to be effective, there is need for scale up to community health facilities and implementation in a manner that explicitly includes community level facilities.

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